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Vascular 2 > Module 5 : Peripheral Arterial System Part 1 > Flashcards

Module 5 : Peripheral Arterial System Part 1 Flashcards

1
Q

14 risk factors for peripheral arterial disease

A
  • diabetic
  • hypertension
  • hyperlipidemia
  • coronary artery disease
  • previous history of CVA or MI
  • smoking
  • age
  • family history
  • male
  • obesity
  • sedentary lifestyle
  • elevated levels of homocysteine
  • excessive levels of C-reactive protein
  • history of radiation
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2
Q

Why diabetes is a risk factor for peripheral arterial disease

A
  • atherosclerosis
  • medial wall calcification common
  • high incidence of gangrenous changes leading to amputation
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3
Q

what arteries have high incidence of occlusion with diabetes

A
  • popliteal

- tibial

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4
Q

why is hypertension a risk for peripheral arterial disease

A
  • increased incidence of peripheral and cerebral atherosclerosis
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5
Q

why is smoking a risk factor for peripheral arterial disease

A
  • irritates endothelial lining and causes vasoconstriction
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6
Q

what are 4 physical signs of peripheral arterial disease

A
  • skin changes
  • palpations
  • auscultations
  • limb pressures
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7
Q

what are the 9 skin changes that can occur with peripheral arterial disease

A
  • pallor
  • rubor
  • dependant rubor
  • cyanosis
  • temperature
  • ulcers
  • gangrene
  • trophic changes
  • capillary refill time
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8
Q

what is pallor

A
  • pale color secondary to deficient blood supply
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9
Q

what is rubor

A
  • dark reddish color or discolouration from dilated or damaged vessels
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10
Q

what is dependant rubor

A
  • limb takes on pallor when elevated but becomes abnormally red when hanging dependant
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11
Q

what is cyanosis

A
  • bluish color of the skin and mucous membranes that results from a concentration of deoxygenated hemoglobin
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12
Q

how does skin temperature change with peripheral arterial disease

A
  • skin feels cool to the touch
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13
Q

what are ulcers

A
  • deep, irregular shaped areas over the tibial area and are very painful
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14
Q

what is gangrene

A
  • results from death of tissue form absent blood supply
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15
Q

what are trophic changes

A
  • due to lack of nourishment

- shiny, scaly skin, thick toenails and loss of hair

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16
Q

what capillary refill time

A
  • pressure is applied to an area of the skin and released
  • color return should be immediate
  • increase in this time indication of poor arterial supply
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17
Q

how to grade and check pulses

A
  • graded from 0-4 where 0 is no pulse and 4 is a bounding pulse
  • compare sides
  • diminished or absent pulses suggest arterial insufficiency
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18
Q

what kind of pulse with an aneurysm have

A
  • bounding pulses
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19
Q

what is a bruit

A
  • abnormal low frequency sounds that can be caused by a significant stenosis graded from 1-3
  • in a > 90% stenosis bruit is not heard
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20
Q

what does a difference in limb pressures indicate

A
  • difference in pressures side to side may indicate disease or > 20 mmHg in upper and low extremity
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21
Q

what are 4 symptoms of peripheral arterial disease

A
  • claudication (intermittent)
  • ischemic rest pain
  • necrosis
  • pseudoclaudication
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22
Q

what is intermittent claudication

A
  • muscle pain that occurs during exercise but subsides at rest
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23
Q

what is claudication caused by

A
  • lack of blood supply to a group of muscles
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24
Q

is claudication reproducible

A
  • yes
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25
Q

what are 4 common sites of claudication

A
  • hip
  • thigh
  • butt
  • calf
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26
Q

where is the site of disease relative to where the claudication occurs

A
  • proximal
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27
Q

what does butt claudication suggest

A
  • distal aortoiliac disease
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28
Q

what does which claudication suggest

A
  • distal external iliac/CFA disease
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29
Q

what does calf claudication suggest

A
  • femoral / popliteal disease
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30
Q

what is ischemic rest pain indicate

A
  • always an indicator of advanced multisegment disease

- precursor to limb loss unless treated

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31
Q

what is the pain with ischemic rest pain

A
  • severe and CONSTANT
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32
Q

what area is usually affected by ischemic rest pain

A
  • dorm (top) of foot and toes
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33
Q

does rest relieve ascetic rest pain

A
  • no
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34
Q

what is necrosis

A
  • tissue death

- end stage of absent blood supply

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35
Q

what is the most severe symptom of ischemic rest pain

A
  • necrosis
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36
Q

what is pseudoclaudication

A
  • pain caused by other factors such such as degenerative joint disease, spinal stenosis, herniated discs
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37
Q

is pseudoclaudication reproducible

A
  • no
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38
Q

what are 3 mechanisms of peripheral arteriole disease

A
  • atherosclerosis
  • embolism
  • aneurysm
39
Q

where is the most common location of atherosclerotic disease in the lower extremity

A
  • SFA at the adductor canal
40
Q

what are 2 other common sites of obstruction in lower extremity

A
  • partial bifurcations

- popliteal artery

41
Q

can atherosclerotic disease be focal or diffuse and what levels does it affect

A
  • both

- may affect any level or multiple levels

42
Q

how can an embolism causes disease

A
  • from stenotic plaque formation
43
Q

what is an aneurysm

A
  • dilation of all walls of vessel

- may contain large amounts of thrombus

44
Q

what are aneurysms usually due to

A
  • trauma

- atherosclerosis

45
Q

what are 3 common areas of aneurysm

A
  • abdominal aorta AAA
  • femoral
  • popliteal artery
46
Q

what are the two common areas of upper extremity aneurysms

A
  • subclavian aneurysms

- ulnar aneurysms

47
Q

what can subclavian aneurysms cause

A
  • cause of embolization to distal arteries of the hand
48
Q

what is most common cause of subclavian aneurysms

A
  • result of compression of the subclavian artery due to THORACIC OUTLET SYNDROME
49
Q

what are ulnar aneurysms caused by

A
  • due to trauma from using hand as a hammer

- HYPOTHENAR HAMMER SNYDROME

50
Q

what are 5 sonographic features of aneurysms

A
  • increased diameter by > 50%
  • image and measure in sag trans AP
  • OUTER WALL TO OUTER WALL
  • color doppler shows to and fro flow along outer wall
  • measure actual lumen size if thrombus present
51
Q

what are the 5 uses of duplex peripheral arterial testing

A
  • determine STENOSIS OR OCCLUSION
  • evaluate BYPASS GRAFTS
  • presence or absence of ANEURYSMS
  • locate stenotic lesions PRE SURGERY OR GRAFT
  • FOLLOW UP
52
Q

what are three limitations to duplex testing

A
  • surface obstructions (dressings staples wounds)
  • obesity
  • Ca +++ in walls (arteriosclerosis)
53
Q

11 indications for extremity duplex

A
  • claudication
  • rest pain
  • extremity ulcer
  • gangrene
  • absent peripheral pulses
  • digital cyanosis
  • arterial trauma
  • aneursymal disease
  • abnormal ABI/WBI/TBI
  • dependant rubor
  • bruit
54
Q

what is one specific indication for a lower extremity duplex exam

A
  • decrease in ABI > 0.15 compared to previous exam
55
Q

what are 5 specific indications for upper extremity duplex exam

A
  • abnormal arterial arm pressures (>20mmHg)
  • thoracic outlet symptoms
  • prior to dialysis
  • cold sensitivity
  • raynauds syndrome
56
Q

what do we look for in the 2D images in duplex exam

A
  • vessel identification and lie of vessels

- assess walls for plaque

57
Q

what doe we look for in the color imaging in duplex exams

A
  • locate and follow vessels
  • vessel patency (stenosis or occlusion)
  • flow direction
  • plaque
  • placement of doppler sample
  • grafts and bypass
  • aneurysms
  • follow up
58
Q

what three things do we asses with pulsed doppler

A
  • confrims patency of vessels
  • quantifies flow speed
  • waveform assessment
59
Q

what arteries are assessed in LE duplex

A
  • distal external iliac
  • CFA
  • CFA bifur
  • SFA
  • pop a
  • trifurcation
60
Q

what is the protocol in areas of suspected stenosis

A
  • measure luminal reduction to help verify velocity data in hemodynamically significant stenosis
  • obtain highest achievable velocity through any areas of stenosis
  • obtain spectral information prox and distal to any stenosis
  • MEASURE LUMEN REDUCTION IN GRAY SCALE
61
Q

what vessels are assessed in upper extremity duplex exam

A
  • subclavian (prox and dist)
  • axillary
  • brachial
  • radial
  • ulnar
  • palmar arch if necessary
62
Q

what is normal PSV of SCA and AXA

A

70-120 cm/s

63
Q

what is normal PSV BrA

A

50-120cm/s

64
Q

what is normal PSV of RA and UA

65
Q

what should you do with the sample volume when stenosis is discovered

A
  • walk the sample volume through the area to obtain representative velocities
    + 2cm prox, highest PSV, distal to stenosis
66
Q

what 4 criteria should we determine in peripheral arterial disease

A
  • plaque location and characteristics
  • PSV and flow characteristics
  • V2/V1 (V2 represents the max PSV and V1 PSV in normal)
  • any change in spectral
67
Q

what should normal gray scale and color look like in duplex exam

A
  • no echoes seen within the lumen

- color doppler fills lumen wall to wall

68
Q

what should normal doppler trace look like in normal LE duplex

A
  • triphasic
  • biphasic may be present without any visualized stenosis and may be considered normal
  • abnormal would be change from tri to bi
69
Q

are PSV uniform normal LE duplex

70
Q

what is mean PSV in external iliac

A

120 +/- 22 cm/s

71
Q

what is mean PSV in CFA

A

114 +/- 25 cm/sec

72
Q

what is mean PSV in SFA prox

A

91 +/- 14 cm/s

73
Q

what is mean PSV in SFA dist

A

94 +/- 14 cm/s

74
Q

what is mean PSV in pop

A

69 +/- 13cm/s

75
Q

what would gray scale and color look like in an abnormal LE duplex

A
  • intraluminal echoes are sen and decreased lumen measures
  • color doppler does not fill entire lumen and color jet seeing narrowed segment
  • color mosaic see due to post stenotic turbulence
76
Q

what would abnormal biphasic doppler signals look like in abnormal LE duplex testing

A
  • strong forward flow in early systole (sharp upstroke)
  • loss of flow in early diastole (non flow below baseline)
  • decrease in late diastolic component
77
Q

what would abnormal monophasic flow doppler signals look like in abnormal LE duplex testing

A
  • decreased pulsatility and no reversed flow in late systole
  • diastolic flow may or may not be seen
  • blunted systolic component t
  • common distal to hemodynamically significant stenosis or occlusion
78
Q

what does a focal velocity increase of >/= double of the prox segment indicate

A
  • hemodynamically significant lesion > 50%
79
Q

what does a focal velocity increase of >/= triple of the prox segment indicate

A
  • hemodynamically significant lesion of > 70%
80
Q

what 4 other things indicate presence of stenosis

A
  • spectral wave form changes
  • post stenotic turbulence
  • color aliasing
  • color bruit
81
Q

what are 3 indirect signs of stenosis when a proximal normal velocity cannot be obtained

A
  • increased velocities with luminal reduction and post stenotic turbulence
  • spectral waveform changes form one segment to next
  • arterial wave form comparison at the same site in contralateral artery
82
Q

what does a staccato wave form indicate

A
  • severe distal stenosis or complete distal occlusion
83
Q

what color parameter indicates a complete occlusion

A
  • flow not detected by cold and spectral doppler in vessel
84
Q

the presence of what vessel can help indicate occlusion extent

A
  • large collateral at the pool and distal ends
85
Q

what characteristics (waveform spectral broadening velocity and distal waveform) will a normal vessel present with

A
  • triphasic
  • none
  • none
  • normal
86
Q

what characteristics (waveform spectral broadening velocity and distal waveform) will a vessel with 1-19% stenosis present with

A
  • triphasic
  • minimal
  • < 30% increase in PSV from proximal segment
  • normal prox and distal
87
Q

what characteristics (waveform spectral broadening velocity and distal waveform) will a vessel with 20-49% stenosis present with

A
  • tri/biphasic
  • prominent
  • 30-100% increase in PSV from prox segment
  • normal prox and distal
88
Q

what characteristics (waveform spectral broadening velocity and distal waveform) will a vessel with 50-99% stenosis present with

A
  • monophasic
  • extensive
  • > 100% increase in PSV from prox segment
  • waveform monophasic distal
89
Q

what characteristics (waveform spectral broadening velocity and distal waveform) will a completely occluded vessel present with

A
  • no flow (pre occlusive thump prox)
  • none
  • none
  • collateral waveform monphasic with reduced PSV
90
Q

what are 3 other correlative diagnostic tests

A
  • CTA
  • MRA
  • arteriography
91
Q

what are 5 medical treatments of peripheral arterial disease

A
  • modify risk factors
  • exercise routine
  • anti-platelet medications
  • anticoagulation
  • thrombolysis
92
Q

what are 5 surgical treatments of peripheral arterial disease

A
  • bypass grafting
  • artherectomy
  • resection
  • sympathectomy
  • amputation
93
Q

what are 3 Endovascular treatments of peripheral arterial disease

A
  • angioplasty
  • stent
  • intraarterial directed thrombolysis

Vascular 2 (9 decks)

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